Depression

Depression

Our moods are long-lasting feelings that affect how we think and feel. It’s normal to feel sad or down when bad things happen. However, people with depression have mood changes that are much stronger or last much longer than usual, making it hard for them to handle everyday tasks and responsibilities.

A study on the prevalence of sadness and depression in high school students found that 9.8% of high school students in Ontario reported feeling depressed “most of the time” or “all of the time.” Female students reported feeling depressed twice as often as male students (14% vs 6%).  For people with depressive disorders, mood changes are more severe and prolonged and affect daily functioning (Nevid et al., 2019). 

Major Depressive Disorder

Major depressive disorder (MDD), also called major depression, is diagnosed when a person has one or more major depressive episodes without any history of manic or hypomanic episodes. During a major depressive episode, the person feels very sad, hopeless, or “down in the dumps,” or they lose interest in almost everything they used to enjoy, and these feelings last for at least two weeks.

• At least 1 in 20 people can be diagnosed with major depression at any given time.
• When left untreated the disorder usually lasts between 6 months to 2 years.
• At least 50% of people who have had major depression have experienced repeated occurrences of the depressive episode with prolonged symptoms. Many professionals are now viewing this MDD as a chronic lifelong disorder (Nevid et al., 2019). 

Symptoms of MDD

• Poor appetite
• Experience significant weight loss or weight gain.
• Physically agitated or exhibit a noticeable slowdown in their movements.
• Loss of interest in usual hobbies and activities
• Difficulty concentrating and making decisions
• Suicidal thoughts and ideation

Treatment/Management

Major depressive disorder (MDD) can be treated through various methods, including medications, therapy, interventions, and lifestyle changes. The first step in treating MDD usually involves medications and/or therapy. Research shows that a combination of both is often more effective than using either one alone. For severe cases, electroconvulsive therapy (ECT) tends to work better than other treatments (Bains & Abdijadid, 2023).

FDA-Approved Medications for MDD:

1. Selective Serotonin Reuptake Inhibitors (SSRIs): These are often the first choice for treatment and include fluoxetine, sertraline, citalopram, escitalopram, paroxetine, and fluvoxamine. They are the most commonly prescribed antidepressants (Bains & Abdijadid, 2023).
2. Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs): Medications like venlafaxine, duloxetine, desvenlafaxine, levomilnacipran, and milnacipran are useful, especially for patients also dealing with pain (Bains & Abdijadid, 2023).
3. Serotonin Modulators: These include trazodone, vilazodone, and vortioxetine (Bains & Abdijadid, 2023).
4. Atypical Antidepressants: Bupropion and mirtazapine are often prescribed alone or to help with side effects from SSRIs or SNRIs (Bains & Abdijadid, 2023).
5. Tricyclic Antidepressants (TCAs): Medications like amitriptyline, imipramine, clomipramine, doxepin, nortriptyline, and desipramine are less commonly used due to potential side effects (Bains & Abdijadid, 2023).
6. Monoamine Oxidase Inhibitors (MAOIs): Tranylcypromine, phenelzine, selegiline, and isocarboxazid are available, but they are used less often because of their side effects and risks in overdose (Bains & Abdijadid, 2023).
7. Other Medications: Mood stabilizers and antipsychotics may also be added to enhance the effects of antidepressants (Bains & Abdijadid, 2023).

Psychotherapy Options:

• Cognitive-Behavioral Therapy (CBT)
• Interpersonal Therapy (IPT)
• Electroconvulsive Therapy (ECT): This is used for serious cases such as acute suicidality, severe depression during pregnancy, refusal to eat or drink, catatonia, or severe psychosis (Bains & Abdijadid, 2023).

Additional Treatments:

• Transcranial Magnetic Stimulation (TMS): Approved for patients who haven't responded to at least one medication.
• Vagus Nerve Stimulation (VNS): A long-term option for those who haven't found relief after four medication trials.
• Esketamine: A nasal spray used alongside an oral antidepressant for treatment-resistant depression in patients who have not responded to other medications.

Persistent Depressive Disorder

Persistent depressive disorder (PDD) is marked by a sudden change from someone’s usual mood, followed by times when they might feel better for weeks or months. This condition includes chronic depression lasting at least two years. People with PDD may experience chronic major depression or a milder form called dysthymia (Nevid et al., 2019). Dysthymia often starts in childhood or adolescence and can continue into adulthood. The word "dysthymia" comes from Greek words meaning "bad spirit," reflecting how individuals often feel low or "down in the dumps" (Nevid et al., 2019). While major depressive disorder can be severe and temporary, dysthymia is usually milder but can last for many years.

In Canada, about 3-6% of adults experience dysthymia at some point, and it tends to be more common in women (Nevid et al., 2019). For those with persistent depressive disorder, feelings of depression can become a regular part of their lives, leading others to view them as constantly complaining. Although dysthymia is less intense than major depression, it can still impact a person's ability to work and socialize.

Symptoms include:

• Sadness, emptiness, or feeling down
• Loss of interest in everyday activities
• Tiredness and lack of energy
• Low self-esteem and self-criticism
• Difficulty focusing and making decisions
• Trouble completing tasks on time
• Becoming easily annoyed or angry
• Avoiding social activities
• Feelings of guilt and worries about the past
• Poor appetite or overeating
• Sleep issues
• Hopelessness

In children, symptoms may also include feeling down and being irritable or easily frustrated (Mayo Clinic, 2022).

Strategies that reduce the symptoms and feelings:

• Take steps to manage stress, improve your resilience to overcome challenges, and enhance your self-esteem (Mayo Clinic, 2022).
• Connect with family and friends, especially during tough times, to help you through difficult moments (Mayo Clinic, 2022).
• Seek treatment as soon as you notice any issues to prevent symptoms from getting worse (Mayo Clinic, 2022).
• Think about long-term treatment to help avoid a return of symptoms (Mayo Clinic, 2022).